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General NPI Number Information
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NPI Number | 1437527165
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Entity Type | Individual
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Provider Name | MELISSA DEANNE JOHNSON DPT
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Gender | Female
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Dates
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Enumeration Date | 09/11/2015
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Last Update Date | 09/11/2015
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Provider Practice Location Address
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Address Line | 2001 WINWARD WAY STE 101
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City | SAN MATEO
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State | CA
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Zip | 94404-2499
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Country | US
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Telephone | 650-571-6800
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 MARLIN AVE
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City | FOSTER CITY
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State | CA
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Zip | 94404-1812
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Country | US
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Telephone | 650-571-5205
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 42582
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License Number State | CA
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